1st North Carolina Volunteers /11th Regiment North Carolina Troops
Application for membership
Name _____________________________________________________Date _______________
(First) (Middle) (Last)
Address _____________________________________City ___________________________________
(Street or Box Number)
State _________ Zip _______________ Phone ___________________________ E-Mail_________________________________________
Occupation ________________________________________Marital Status __________________________
Date of Birth (Month / Day / Year ) _________________________Present Age ____________________
*If you are 16 years of age or younger, your parent’s or guardian’s consent is required in writing to the recruiter and an emergency medical release form signed by them
Education: High School Graduate________ College Graduate ___________ Degree_____________________
Military Service: ________________________________________________________________________________________
(Branch) (Rank) (Years Served)
Discharged honorably from the service ( Yes / No) If NO, please explain: _________________________________________________________________________________________
Are You a U.S. Citizen? __________ If not, what country? ____________________________
Condition of Health? ________________ *Are you presently under a Doctor's care or medication?_________
*(Explain if a health condition might interfere with physical stress connected with outdoor activities)
Have you ever been convicted of a felony? If yes, please explain the nature of the conviction: _______________________________________________________________________________
Are you presently a member of any other re-enactment unit, N.S.S.A., S.N.S.A., or round ball muzzle loader group? If so, please list them. _________________________________________________________________________________________
I understand, acknowledge, and am aware of the following conditions, potential hazzards, and expectations:
That there are potentially hazardous risks associated with participation in the hobby of reenacting including varying degrees
of physical exertion and that any physical limitations on my part must be immediately reported to the commanding officer.
That I am presently not a member of, nor have ever belonged to, any subversive groups or organizations.
That to fully participate with the 1st NC Vols /11th NC Troops, I will initially (within 18 months) need to make a sizeable investment of money in authentic uniforms, musket, accoutrements, and required equipment as specified by the by-laws and the Inspector General of the 1st North Carolina Volunteers / 11th North Carolina Troops.
Furthermore, I pledge that the questions on this application have been answered truthfully and understand that any untruthful answers or statements on this application or ungentlemanly conduct while representing the 1st NC Vols/11th NC Troops could result in termination of my membership. Finally, I agree to abide by all regulations and By-Laws of the 1st NC Volunteers/11th Regiment North Carolina Troops.
* (Applicant’s Signature) * (Event/Place and Date of Interview)
*(Parent/Guardian Signature if applicant is under 18)
* (Regimental Sponsor) (Accepted / Rejected)
* MUST BE COMPLETED IN ORDER TO BE PROCESSED
Dues: $60.00 Military, $60.00 Civilian/Junior Reserve, Make Checks payable to: 1st NC Vols.
Please mail check and completed application to:
1st Lt. Lee Gordon, 383 St. Marys Rd, Hillsborough , NC 27278